Ms Patel has a health insurance plan with a sum insured of INR 5 lakh with an unlimited sum insured refill add-on. At the start of the year, she had to undergo surgery following an accident that cost her INR 2.5 lakh. With her health insurance, she was able to cover her operation costs without spending her savings. In the same year, Ms Patel had to undergo a heart surgery the cost of which was INR 3 lakh. Like before, her health insurance policy covered all her medical costs, thanks to the unlimited refill benefit. You can find information on the unlimited refill benefit in health insurance below.

What is unlimited refill benefit?

The unlimited refill benefit is an add-on cover that you can purchase along with your base health insurance plan. With this add-on, the insurance provider replenishes the sum insured benefit when it gets exhausted. Additionally, there is no limit on the number of times the sum insured can be restored in a policy year.

When Ms Patel had her first operation, she used up INR 2.5 lakh from her sum insured. Her first claim triggered the unlimited refill benefit wherein her insurance provider restored her sum insured to the original sum insured limit. This allowed her to undergo another surgery in the same policy year without breaking her bank.

Types of unlimited refill benefits

The unlimited refill benefit can be classified into the following:

• Refill benefit for partial exhaustion

With this type, the insurer restores the basic sum insured upon using a portion of the sum insured. For instance, if Ms Patel files a claim of INR 75,000 for accidental injuries from her sum insured of INR 5 lakh, the insurance provider restores the sum insured to INR 5 lakh after her first claim.

• Refill benefit for complete exhaustion

In this case, the insurance provider refills the sum insured amount only when 100% of the sum insured is consumed. For instance, if Ms Patel exhausts her INR 5 lakh sum insured to pay for an expensive treatment, her entire sum insured is replenished to INR 5 lakh.

Unlimited refill benefit and family floater plans

In a family floater health insurance plan, all family members insured under the plan share a single sum insured limit. When one member uses up a portion of the sum insured, the insured members can only access the balance sum insured.

Let’s say Ms Patel purchases a family floater plan of INR 10 lakh to cover her spouse and two children. Her spouse files a claim worth INR 4 lakh for a knee surgery. In this case, the family can only get cover for subsequent medical expenses up to INR 6 lakh. Ms Patel must finance the expenses exceeding INR 6 lakh from her own pocket.

In case of family floater plan, it would be prudent to opt for an unlimited refill benefit. With this cover, when one member uses the sum insured, the other members can still use the original sum insured. This way, Ms Patel can ensure that her family members are appropriately covered and prepared to face any medical emergency.

Factors to consider

When it comes to the unlimited refill benefit in health insurance, you should keep the following factors in mind:

• You need to use it in the same policy year

If you do not use the unlimited refill benefit in the existing policy year, you cannot carry forward it to the next year. The unlimited refill benefit triggers when a claim is filed. Hence, if Ms Patel does not file a claim during her ongoing policy period, she cannot use the unlimited refill benefit in the following policy period.

• You need to renew it with your policy

The unlimited refill benefit is an additional cover you can purchase with your base plan. To ensure you are covered by this benefit always, you need to renew it along with your policy. Also, if you’re not already covered by the unlimited refill benefit, you can purchase it at the time of policy renewal.

• It does not cover any one illness

In health insurance, ‘any one illness’ refers to a continuous period of illness. It includes relapse within 45 days from the last consultation’s date with the healthcare facility where you received the treatment. The unlimited refill benefit does not apply to such conditions.

• It will be applicable to certain specific base covers

The unlimited refill benefit shall be applicable to certain types of claims. This can differ from insurer to insurer. Therefore, Ms Patel must read the policy wordings thoroughly to understand the inclusions and exclusions.

Related vs unrelated medical conditions

In most cases, the unlimited restoration in health insurance is triggered for unrelated illnesses. Unrelated illness means that the illness for which the claim is filed should be different from the one at the time of the first claim. For instance, if Ms Patel uses the sum insured to cover a bypass surgery, the insurer will refill the sum insured if the next claim is filed for a condition other than a bypass surgery in the same policy year. In case of related illness, Ms Patel can avail of the unlimited refill benefit even if she files a claim for the same surgery again.

Get unlimited refill benefit for both, related and unrelated illnesses with SBI General Insurance’s Health Edge policy.

Ensure maximum coverage at all times with SBI General Insurance’s Health Edge plan

Health Edge Insurance is a completely digital health insurance offering from SBI General Insurance. It comes with 9 basic indemnity plans. These include in-patient hospitalisation, pre and post-hospitalisation, day care treatments, advanced treatments, bariatric surgery, alternative treatments, etc. You can choose from our 18 optional covers to customise your plan as you desire. By opting for the unlimited refill rider, your base sum insured is restored to 100% limitlessly upon claiming medical expenses. This benefit is triggered when you file the first claim. Your sum insured will be restored for all the following claims. What’s more, the benefit covers both, related and unrelated illnesses.

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